The purpose of Avera Health's Improving Quality Through the Use of E-prescribing With Electronic Decision Support Project is to examine whether, in rural ambulatory care settings, the use of an electronic prescribing system with clinical decision support related to medication management increases patient prescription adherence, improves health outcomes in hypertensive patients and improves the medication management process. As part of its overall Avera HealtheCARE(tm) Initiative, the health system is working with 28 hospitals and 116 clinics to implement a regional EMR. The technology package will include advanced electronic prescribing software that provides physicians the capacity to track the fill status of prescribed medications, as well as provide interaction alerts, formulary listings, dosing options, patient medication history, and printed wallet-size medication lists. The study will examine the impact of the technology on the medication management of hypertensive patients in nine rural/frontier primary care facilities. Specific objectives of this research are: (1) to improve the rate of patient adherence to prescribed medications among hypertensive patients in rural communities, (2) to impact adherence to prescribed medications among hypertensive patients through utilization of electronic prescribing tools in rural care settings, (3) to impact health outcomes for hypertensive patients in rural communities through the use of electronic prescribing and associated clinical decision support tools, (4) to enhance patient and provider satisfaction with the electronic prescribing tool, and (5) to overcome barriers to successful adoption of electronic prescribing. The proposed study will take advantage of a staged implementation, first gathering baseline measures, then tracking clinics using e-prescribing as a stand alone tool before moving to an EMR, and those clinics moving directly to the EMR with integrated e-prescribing. To examine whether patient prescription adherence improves, medical claims data and the e-prescribing patient-fill histories will be used. Improved outcomes will be measured in blood pressure levels, and changes in treatment for patients with blood pressure over 140/90. Patients and providers in rural communities face unique challenges with medication management. The long- term goal is to see if and how health IT helps overcome these obstacles. Avera Health is dedicated to improving the lives and health of citizens within the rural communities it serves. The Electronic Prescribing and Decision Support to Improve Rural Primary Care Quality Project sponsored by Avera Health is relevant to public health because of the implications it has for health care in rural and frontier America. The project will enable rural and frontier clinics to determine whether electronic prescribing and electronic medication management decision support tools for physicians will help provide better care for patients, and result in improved health status for these patients. Rural and frontier clinics serve a disproportionate share of elderly patients who require extensive medication therapy to manage their health;making e-prescribing more important.